Open Journal of Pediatrics, 2013, 3, 364-365 OJPed http://dx.doi.org/10.4236/ojped.2013.34065 Published Online December 2013 (http://www.scirp.org/journal/ojped/ ) Gangrenous Amyand’s hernia in neonate: A great clinical masquerader Vaibhav Pandey * , Ajar Narayan Gangopadhyay, Dinesh Kumar Gupta, Shiv Prasad Sharma Department of Paediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India Email: * sunny.imsbhu@gmail.com Received 14 August 2013; revised 12 September 2013; accepted 20 September 2013 Copyright © 2013 Vaibhav Pandey et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. ABSTRACT Amyand’s hernia [AH] is a rare condition with pres- ence of vermiform appendix in an inguinal hernia sac [1]. It is a rare entity with very difficult preoperative diagnosis that does not affect management. We herein report a neonatal gangrenous AH masking all fea- tures of underlying bowel gangrene. In neonates, a great masquerader can mask all the features of un- derlying bowel gangrene and delay in diagnosis can be detrimental in context of outcome. A high index of suspicion of Amyand’s hernia with gangrene should be kept even if child presents with irreducible hernia without features of strangulation to prevent avoidable increase in morbidity and mortality. Keywords: Hernia; Gangrenous Appendix; Strangulation; Inguinal; Appendicitis 1. INTRODUCTION Amyand’s hernia is a rare condition with presence of vermiform appendix in an inguinal hernia sac [1]. Preop- erative diagnosis of Amyand’s hernia is very difficult and it is often misdiagnosed as incarcerated [1]. We herein present a case of neonatal gangrenous Amyand’s hernia masquerading clinical features of strangulation. 2. CASE REPORT A 25-day male baby, who had a right-sided reducible inguinal hernia since birth, presented with a 2-day- history of sudden increase in size and irreducibility of the hernia. There was no history of vomiting or abdominal distension and child was taking feeds normally. On examination child was active, afebrile with heart rate of 134 beats per minute. Abdomen was soft with normal bowel sounds. There was a pear-shaped right inguino- scrotal swelling which was tense, tender, and irreducible with normal overlying skin (Figure 1). Diagnosis of right irreducible inguinal hernia was made. X-ray abdo- men was normal. Child was started on intravenous anti- biotics, fluids and prepared for surgery. Child was ex- plored after 24 hours of admission, on opening the her- nial sac through right inguinal skin crease incision, gan- grenous appendix was found to be lying within, with dense adhesions to the sac. The incision was extended towards scrotum and appendix of size 4 cm was released (Figure 2). Appendicectomy and herniotomy were per- formed and the patient transferred to the ward, where he had an uneventful postoperative stay. 3. DISCUSSION The presence of an appendix within the inguinal hernial sac is defined as Amyand’s hernia. The incidence of having a normal appendix within an inguinal hernial sac is about 1%, whereas only 0.1% of all cases of appendi- citis present in an inguinal hernia [2]. Contrary to appen- Figure 1. Irreducible swelling of right inguino-scrotal region. OPEN ACCESS